New tip sheet explores substance use disorders in older adults

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Substance abuse among adults over 60, particularly of alcohol and prescription drugs, is one of the fastest-growing health problems in the United States. The National Center for Equitable Care for Elders (ECE) at Harvard estimates that some 5.7 million older people needed treatment for substance use disorders in 2020, about triple that in 2000.

Prescription drug abuse affects up to 17% of older adults, according to The National Institute on Alcohol Abuse and Alcoholism (NIAAA). However, this problem remains underestimated, underidentified, underdiagnosed, and undertreated, aging experts say. Substance use disorders or addictions may be mistaken for other age-related conditions or fall completely off a clinician’s radar as they manage other age-related conditions like diabetes, heart disease, frailty, or cognitive decline. Journalists may be missing out on important story coverage as states and communities readjust their health care priorities in the wake of COVID-19 budget shortfalls.

Older people are more vulnerable to substance abuse or misuse because many may take more medications than necessary to treat their conditions. Medications metabolize more slowly, and older brains may be more sensitive to drugs, according to the National Institute on Drug Abuse. For some, cognitive decline can contribute to confusion about what, when, and how much medication needs to be taken. Risk factors may vary considerably by substance and the specific clinical presentation of a patient (e.g., age, medical comorbidities, current medications, and health history), according to a 2014 study.

Although many prescribed medications have the potential to be abused or misused, several drugs are chiefly involved in misuse: opioids, frequently provided for pain relief; central nervous system depressants, prescribed for anxiety and sleep disorders; and stimulants, prescribed to treat sleep disorder narcolepsy and attention-deficit hyperactivity disorder (ADHD). These three drugs can alter the brain’s activity leading to addiction.

In addition to alcohol, marijuana (medical or recreational), cocaine, and tobacco use were also widely reported among those identified with dependency or SUD. Clinicians must screen for SUD among older patients, wrote Susan Lehmann, M.D., director of the Geriatric Psychiatry Day Hospital Program and associate professor of psychiatry and behavioral sciences at Johns Hopkins Medicine, said in a New England Journal of Medicine article. “Since older patients may lack awareness that their substance use is problematic or harmful, it is important that the assessment includes input from family members and acquaintances who know the patient well.”

Older adults may turn to alcohol, illicit or prescription medications for many reasons, according to researchers. Among them being:

  • Retirement
  • Death of a spouse or partner
  • Moving to a long-term care facility
  • Loneliness
  • Social isolation
  • Mental or physical health decline

The COVID-19 pandemic has exacerbated isolation and loneliness and left many older adults coping with the loss of a family member or experiencing symptoms of “long COVID.”

A new tip sheet on SUD and older people highlights data and story ideas for covering what some aging and mental health experts fear may be an increase in self-medication through drugs or alcohol among this cohort.

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